S L I D E 1

FBR Model Overview

•  In Connecticut, adult substance abuse treatment and child welfare services have been funded and managed by two separate state agencies: – Department of Mental Health and Addiction Services

(DMHAS) – Department of Children and Families (DCF)

•  DCF recognized the need to address the dual challenges of many families: parenting and substance abuse

S L I D E 2

FBR Model Overview

•  In 2006, DCF invited two university programs to partner in this initiative: –  Johns Hopkins University & the University of

Maryland – contingency management substance abuse treatment (Reinforcement-Based Treatment; RBT)

– Yale Child Study Center – attachment-based parent-child therapeutic approach (Coordinated Intervention for Women and Infants; CIWI)

•  Family-Based Recovery (FBR) was designed as a home-based intervention, which merged these models of parenting support and substance abuse treatment

S L I D E 3

FBR Mission

The mission of FBR is

1) to ensure that children develop optimally in drug-free, safe and stable homes with their parent/s

2) to develop a replicable, evidence-based, in-home practice model

S L I D E 4

FBR Clients

•  A parent who is actively abusing substances and/or has a recent history of substance abuse (w/in 30 days)

•  A child who is:

–  under the age of 24 months –  resides with the index parent at the time of

referral, or

–  in foster care with a plan for imminent reunification

–  at risk for removal from parental custody

S L I D E 5

FBR Team

FBR Teams are composed of: •  2 Full-Time Master’s level clinicians

•  1 Full-Time Bachelor’s level Family Support Specialist

•  A Half-Time Supervisor

•  A Part-Time Psychiatrist

S L I D E 6

FBR Team: Caseload Structure

•  An FBR caseload is twelve families

•  Each clinician provides:

– Parent-child-related interventions to 6 families

– Caregiver sobriety-related interventions to 6 families

•  The Family Support Specialist works with all 12 families

S L I D E 7

Assessment Phase

Partnering with Parents: The FBR Team completes with the client:

–  Genogram –  Parenting Stress Index – Short Form –  Postpartum Bonding Questionnaire –  Edinburgh Depression Scale –  the Gain-Q –  Functional Assessment for each substance

–  Brief Substance Abuse Assessment –  Sobriety Sampling Contracts as needed

–  Urine toxicology screens and breathalyzers

S L I D E 8

Parent/child Intervention

•  The parent/child clinician explores: –  The parent’s aims and goals for the intervention

–  The parent’s perceptions of the child

–  The goodness of fit between parent and child

–  The parent’s beliefs regarding child development

–  The time the parents and child spend together

–  The parent’s feelings about being a parent: what’s pleasurable, what is a challenging

S L I D E 9

Substance Abuse Intervention

•  Functional analysis of use, periods of nonuse and any relapses that occur during treatment

•  Feedback session and feedback report

•  Contracting for sobriety-supporting behaviors

•  Graphing sobriety and sobriety-supporting behaviors (e.g., recreation, job goals) and assistance in understanding the links between graphed behaviors

•  Frequent, intensive social reinforcement for graphed behaviors

S L I D E 10

Quality Assurance Goals

•  Ensure accurate and timely data collection

•  Monitor caseloads

•  Monitor adherence to clinical services inherent to FBR model (e.g., FBR Tools and Measures)

•  Examine results of clinical measures and urine toxicology screens

•  Summarize all of the above in quarterly reports for providers and DCF

–  One network (aggregated) report –  Six site-specific reports on programmatic adherence and clinical

outcomes

S L I D E 11

Length of Stay

Median Length of Stay = 6.28 months

S L I D E 12

Case and Caregiver Characteristics

•  Across all six regional providers to date, 389 cases served (830 clients); about 20-25 new intakes per quarter

•  84% of families served are headed by single mothers

•  Average cash household income: $679/month

–  Non-cash: 72% Medicaid, 68% WIC, 68% food stamps

•  Average maternal age: 27.1 years (s.d. = 5.7 years)

•  Maternal Race/Ethnicity:

–  51% Caucasian; 30% African-American; 15% Hispanic/Latina

•  Marital Status: 74% Single, never married

•  Educational Attainment: 70% HS diploma/GED or less

S L I D E 13

Maternal Risk Factors

S L I D E 14

Urine Toxicology Screen Results

S L I D E 15

Urine Toxicology Screen Results

•  To date, a total of 17,298 urine toxicology screens have been administered

•  Among these, 79% have been clean, 21% have been positive for one or more substances

•  Among all positive screens: –  53% of positive screens were for marijuana

–  26% prescription drugs

–  17% cocaine

–  6% opiates

–  5% PCP

–  5% oxycodone

S L I D E 16

Clinical Measures

Measures N Pre-Test Score

Post-Test Score

T-Score and Significance

Edinburgh Depression Scale 174

Total Score 7.24 5.01 5.20 **

Parenting Stress Index-Short Form 163

Total Score 68.03 61.55 5.42 **

Parenting Distress 26.30 22.65 6.15 **

Parent-Child Dysfunctional Interaction 18.99 17.00 4.37 **

Difficult Child 22.47 21.56 1.74 NS

Parental Bonding Questionnaire 149

Total Score 5.79 4.37 3.35 **

Impaired Bonding 3.42 2.66 2.87 **

Rejection-Anger 0.74 0.70 0.33 NS

Anxiety-Care 1.61 1.01 3.44 **

Risk of Abuse 0.03 0.01 1.14 NS

S L I D E 17

Placement of Index Child

76%

8%

3%

8% 1% 4%

Child Placement at Discharge (Program to Date)

S L I D E 18

Summary of QA Findings

Children remain in their homes:

– FBR Result : Among a high-risk sample of substance abusing parents, 84% of children remain in their homes at discharge

Parents reduce substance abusing behaviors:

– FBR Result : 50% positive urine screens at Week 1; 17% positive screens at Week 15

Parents address other clinical symptoms:

– FBR Result : Statistically significant, positive changes on measures of parenting stress, bonding to infant, and depression

S L I D E 19

Acknowledgements

Yale University Jean Adnopoz Karen E. Hanson Jeffrey J. Vanderploeg Dale Saul Jeanette Radawich Amy Myers Christian M. Connell

University of Connecticut Jo Hawke Karen Steinberg

Johns Hopkins/U. of Maryland Michelle Tuten Cindy Schaeffer Jennifer Ertel

State of Connecticut Dept. of Children & Families Robert Plant Peter Panzarella Francis Gregory Tere Foley

For more information please contact Karen Hanson at karen.hanson@yale.edu